Do we really need a Quantative at EOT instead of a Qualitive?

[Xenigma]

If we've been UND through tx, do we really need a Quantative at
EOT?  All we really need to know is if we relapsed right?

If we have a qualative that reads to 5 wouldn't that serve the purpose?

I'd like to know what you guys think-
Thanks...
enigma

[Xenigma]

and I can't spell  LOL
Quantitative vs.Qualitative at EOT

[Xenigma]

Thanks Trin, I have also requested a qualitative test,
I had doc change my EOT lab orders.

I will find the thread and what copyman wrote.  

Thanks again...
enigma

[Bobby1952]

   At EOT Qualititive is probably better because it tests < 5. But after that lets say at the 3 month post eot mark it really doesn't matter. Hep c doesn't exist at very low numbers. Once it comes back it will be in the hundred thousand mark or even millions. At that point Qualititive will tell you that it is back and Quantitive will tell you it is back and at what amount.

Bobby

[jmjm530]

No. A sensitive qualitative at EOT -- or post treatment -- is all you need. In fact, that's all you really need once you become UND via a sensitive quantitative even during treatment. The qualitative I took post treatment was Quest Lab's " HCV RNA Qualitative TMA". It is sensitive down to 5 IU/ml. The results either say "virus detected" or "virus not detected". And that's what's really important once you become UND during treatment via a quant.

-- Jim

[Xenigma]

That's the test I had them change me to Jim.
The nurse had originally put the one that measures to 50.(Quest 35645)
I was not comfortable with that at EOT since all through tx I had Labcorp that measured to 10 when I had United Health.  Now I have BC/BS-so I had the nurse change the test to
Quest #10073-HCV RNA Quant. TMA. It measures from 5 to 7,500.

Thanks all for confirming I made the right choice.
Enjoy the rest of the weekend...
enigma

[portann]

Dear Enigma,

I'm sending you my warmest thoughts and hope you don't mind my bringing back this old thread.

Just wanted to check on something in your above post from July in which you wrote :

      'Quest #10073-HCV RNA Quant. TMA. It measures from 5 to 7,500.'

Is the 'Quant.' you mention above a typo and did you in fact mean "Qual.'?  

I notice Jim referred in the previous post to 'Quest Lab's " HCV RNA Qualitative TMA", so I assume you meant the one he recommended.

Did you have a  Quest #10073-HCV RNA QUA 'L' ITATIVE TMA at EOT in August? And is this the correct and universal code for this Quest qualitative?

May I also ask which test you plan to use for your upcoming twelve week post-treatment test? (I hope I have the timing right.)

Have you looked into an alternative test for your twelve week post tx or is the Quest #10073 still a gold standard?


Do you (or anyone) have an opinion about whether all Quest labs are generally cut from the same cloth in terms of quality control, so that if someone opts for a small town lab, she can expect reliable results?


Thank you, Enigma, for your support since I first arrived here in July.  I sure wasn't thinking about tests back then but only about spilling my injection down my leg!  

I'm keeping my fingers crossed for you and thinking about you.

[apache1]

Check this thread out, chock full of info on eot tests and all the names and best test available, with reasons why.

http://www.medhelp.org/posts/show/383166

Pay particular attention to Hepatitis Researcher posts. He is the man that created the newer labcorp <2 test.
We are very lucky imo to have a member like Hepatitis Researcher here sharing info with us, incredible information resource.

apache1

[portann]

Thanks, Apache! That's a wonderful thread - I think certain threads like the one you brought to our attention should be in some sort of honor box.

Thanks again. If I remember, you've recently been interested in testing, just as I've been.

[geterdone]

I will say that after this discussion and going into EOT I did use the LabCorp's HCV Quantasure Plus (Quantitation) test at the end of the STD SOC and was <10 and again at the end of tapering off the meds 4 weeks later along with LabCorp HCV  N G I  quantasure quantitative LC#140639 at that point both test came back <10 / <2. The last PCR test at 6 months was with the LabCorp HCV  N G I  quantasure quantitative LC#140639 and again the test came back <2. Now if that ain’t anal Paranoia I don’t know what is. But I can tell you one thing and the old timers can tell ya there ain’t going to be any livers hanging by my fire place this Christmas cuz all the lights on are out. Lol

goterdone

I all depends on how much comfort level you need, I needed a lot!

[apache1]

Ya got to love that <2 @6 mo eot... ya baby SvR

In all reality, HR said that test is really good down to maybe less <1or 0
Thats what I call UND baby.
HR says that they have to guarantee the test to 'only' <2 but it should do better as long as the virons are not covered in lipids and don't get forced to the bottom in his ultra high speed ultrafuge at ngi ...iirr

labcorp #140639 <2 is my next 8wk test, next tues, did my 8th shot tonight. My 4 wk was the <50 from quest, it came back und.
I am less than satisfied with the Quest<50 test, was suppose to be the <5 heptimax but the lab screwed it up and now i will never know how UNd I really was at 4 weeks. Hope it never amounts to anything in how i should have adjusted tx.  

apache

[apache1]

Yes I agree, there should be a place for sticking the best threads to a knowledge base forum or something...took me days of searching to find some of the best hep c info on the net, right here, in these forums.

So many great knowledgeable members here.

In my above post portann, you can see why I have  recently been interested in testing.

apache

[Facta_non_verba]

OK, this may sound like a stupid question, but what's the reason for someone to get an EOT test at all? If someone has a sensitive test four weeks before EOT that is UND, how could a positive or negative EOT test be useful?

If the EOT is UND, it doesn't mean that person is cured. Yeah, it's good news, but it doesn't say anything about what the same test will show even a few weeks off treatment.

If the EOT is positive, the story's over. I don't think there are any options open for that person to do anything except to wait and treat later.

It seems to me that the only reason to get tested after finding that you're UND by the 24 week mark is to be able to stop treatment if you have a persistent breakthrough so as to avoid futile treatment.

That said, I plan on getting an EOT sensitive test since it might have some value if I had to re-treat for my doctor to know that I didn't finish treatment UND.

Any thoughts on this?

Jeff
Facta non Verba

[Xenigma]

The test I plan on using for my 3 month post tx is
Quest's HCV RNA QUANT TMA.

I had to switch insurance and therefore I can't use Labcorp anymore -
unless I want to pay.  I did like Labcorp better-
maybe 'cause I used them for so long.  

[jmjm530]

(1) For those that want to TOTALLY simplify things I suggest getting Quest's "Heptimax" before, during, at EOT, and post treatment. It's quantitative but it does use TMA technology and is sensitive down to 5 IU/ml. The other point is that all your doc has to do is write "Heptimax" on a rx and you can bring it down to a local Quest Service Center. Even a doctor can do that! Alternatively, if the doc has a Quest requisition form -- or Quest Account -- he can write "Heptimax" on the form and either draw blood in his office or again, give you the form and you can go to a Quest Center.

(2) Almost as simple, use "Heptimax" both before and during treatment until you are Undetectible. Then switch to Quest's "HCV RNA QUALITATIVE TMA", abbreviated on the report as "HCV RNA QUAL TMA".  That's the test I've used at both EOT (end of treatment) and post treatment. Doctor simple to interpret. It either says "virus not detected" or "virus detected". NPs can understand that as well! Like Heptimax also sensitive down to 5 IU/ml. Earlier in the thread a code number was given for this test but I am not positive this is a universal code.. Double check with your local Quest lab or simply have your doctor write it out as above.

Facta,

The reason for an EOT test is to distinguish between viral breakthrough and relapse in case the treatment fails. For example, if EOT test is positive, then you have viral breakthrough, If no EOT test, you would never have known if breakthough or relapse. This is important info in a re-treatment scenario.

[jmjm530]

EOT test should be taken 6-7 days after your last injection.

[jmjm530]

I'm sure there is nothing wrong with Quest's "Quest's HCV RNA QUANT TMA" but it is not the test you referenced (per my previous post) in your July 5 (9:12) post in this thread. That would be Quest's HCV RNA QUAL TMA. No reason 3 months post treatment for them to be diddling around trying to quantify a virus. All you really want to know then is if you are UND or not and that is what a QUAL tells you.

[nygirl7]

I have had TMAs all through the end of my treatment however be warned they CAN give you a false positive easier than a PCR and that is indeed what happened to me when it came back at 60.  The doctor knew that it was a false pos becuase had the virus come back it would have been a much larger number however I refused to believe him and thought I had relapsed. I had to wait and test again and indeed it did come out negative - however there is a chance of cross contamination with these tests so IF it DOES come back with some extremely low number - DO NOT PANIC, we've seen it happen several times in here and they've all turned out to be falsies :)

Just something to remember just in case because boy I thought I was going to die when I got that number back ... after 72 weeks it broke my heart but either it tried to come back and my body killed it or it was never really there to begin with.  I truly believe the latter.

My tests were all down to <2 post treatment at Dr. Js insistence - he says "why not" and I agree!

[nygirl7]

I have had TMAs all through the end of my treatment however be warned they CAN give you a false positive easier than a PCR and that is indeed what happened to me when it came back at 60.  The doctor knew that it was a false pos becuase had the virus come back it would have been a much larger number however I refused to believe him and thought I had relapsed. I had to wait and test again and indeed it did come out negative - however there is a chance of cross contamination with these tests so IF it DOES come back with some extremely low number - DO NOT PANIC, we've seen it happen several times in here and they've all turned out to be falsies :)

Just something to remember just in case because boy I thought I was going to die when I got that number back ... after 72 weeks it broke my heart but either it tried to come back and my body killed it or it was never really there to begin with.  I truly believe the latter.

My tests were all down to <2 post treatment at Dr. Js insistence - he says "why not" and I agree!

[nygirl7]

I have had TMAs all through the end of my treatment however be warned they CAN give you a false positive easier than a PCR and that is indeed what happened to me when it came back at 60.  The doctor knew that it was a false pos becuase had the virus come back it would have been a much larger number however I refused to believe him and thought I had relapsed. I had to wait and test again and indeed it did come out negative - however there is a chance of cross contamination with these tests so IF it DOES come back with some extremely low number - DO NOT PANIC, we've seen it happen several times in here and they've all turned out to be falsies :)

Just something to remember just in case because boy I thought I was going to die when I got that number back ... after 72 weeks it broke my heart but either it tried to come back and my body killed it or it was never really there to begin with.  I truly believe the latter.

My tests were all down to <2 post treatment at Dr. Js insistence - he says "why not" and I agree!

[Xenigma]

I have 3 choices on my lab slip for Quest...

HCV RNA QUANT. TMA  (which I took at EOT)
load of detection 5–7,500
Confirm infection; assess likelihood of non-sustained
response at end of treatment.


HCV RNA by PCR QL
load of detection 50
Confirm presence of chronic HCV infection; differentiate
between resolved and active infection.

HCV RNA QN PCR
load of detection 50–50,000,000
Establish viral load at baseline; monitor viral load during therapy; determine duration of treatment;
assess likelihood of non-response during treatment.

http://www.questdiagnostics.com/hcp/intguide/jsp/showintguidepage.jsp?fn=TG_HCV_MolecularTesting.htm

So which box should I check??
The QL that measures down to 50

[portann]

That's a surprise. Why the heck is there no choice for the Qual TMA?

Someone please make this easy.  I'd check the Quant TMA on a lab slip like that but is there somehow a problem with the slip itself?

[jmjm530]

Of the three, I'd choose quant because of the lower detection limit.

However, my first choice would be what I took which is not on your list.
That test is Quest's "HCV RNA QUALTIATIVE TMA" often written
"HCV RNA QUAL TMA".  My second choice, also not on the list would be "Heptimax". I pick these two because of their low detection limit, endorsements by docs that use them and my own familiarity with the tests.

If you can't get either of the two I mentioned, I'm sure the quant is fine, I'm just not as famliar with it.

-- Jim

[Xenigma]

Jim...
Yours is the Qual TMA and mine is the Quant TMA.

Portann...
Lab slip is already printed for my Dr. with what he likes to use from Quest (I assume).

Heck, I dunno  LOL  I'm so used to Labcorp.
I'm tired and hungry - Not in that order.
I'll check in later on...
Be well
enigma

[alagirl]

well... I just had my 6 - 7 month post tx SVR test done (yeah I'm a little late, so sue me) and they marked it incorrectly as a hep panel (those folks are BRIGHT let me tell you).  I had to leave my blood and go back to my town, which is an hour away, and call back to get it straightened out because they shut the door right behind me at the doc's office to go to lunch and I went to a lab to have my draw - didn't know it was incorrect until they'd already drawn my blood.  It was all I could do just to get the Quant PCR done because I couldn't see the form and decided rather than have them screw it up again just to give them the test I knew for sure was there under a specific heading.

But hey.  If it comes back and I have a viral load then I'll get a Qual.  Right before I shoot myself in the head...

[alagirl]

They did a taqman down to 15 in sensitivity I'm sure.  that's what they always use.

[alagirl]

you know, when they aren't randomly selecting hep panel on the form...

[Xenigma]

Alagirls statement about getting her test has messed me up and for some reason
I can't get these tests straight.
It's like I have a barrier with the testing and it's pizzin' me off!..
She writes...
It was all I could do just to get the Quant PCR done
But hey.  If it comes back and I have a viral load then I'll get a Qual.
Is the below true?...

A QUANTITATIVE test...
If virus is detected it will give you your Viral load if it's above the lower limit of the test.
If it is under the lower limit of the test it will say UND.

A QUALITATIVE test...
will have either virus DETECTED or NOT DETECTED (no vl given)

If true then why get a Qual. done after if her Quant. test shows a viral load?  
Wouldn't it be the other way around?

I would think that if you get a Qual. done and it shows virus detected then
you'd get a Quant. to see how what the vl is.

[jmjm530]

A quant gives you the number of virons within the test range. In other words it QUANTIFIES your result.

A qual will just tell you if the virus is undetected or detected per the sensitivity of the test. In other words it QUALIFIES.

In the past, Qual's were more sensitive than quant's but that has changed and now some quants are actually more sensitive than quals. A lot of confusion comes out of this because often Quals are used synonomous with sensitive testing and quants synonymous with less sensitive testing. No longer true.

To further complicate things, TMA  used to be synonymous with sensitive test and pcrs with less sensitve tests. But again, not true anymore as labcorp, I believe has a PCR more sensitive than a TMA. Also, not all TMA's are qual's as some are quantified such as with Heptimax.

Confused yet? Well, join the club who has lots of members including doctors and nurses who treat HCV.

Unless you really want to know -- and in that case you need to really study up -- my advice is not to get too focused on all of this. Just use the most sensitive test available post treatment and be done with it. Some of these tests were discussed before.

BTW I have no idea why Ala would want a qual if the quant was positive -- but my guess is what she meant is that she would re-test a positive (always a good idea) and use what she thinks is a better, more accurate test (the qual). Is the qual a better and more accurate test? Well, I suppose that depends on which qual against which quant but here we go again :)

Again, I think this is why "Heptimax" was invented. One test. All scenarios.

-- Jim